Thursday, November 29, 2018

When IVF doctors do not have all the answers

One of the
problems with IVF is that we often don't have answers to our patient's
questions.

This is particularly
true when an IVF cycle fails, even though the embryo was top quality ; the
endometrium was perfect ; and the transfer went smoothly. Now patients demand
answers , and doctors are under a lot of pressure to provide these !

The commonest
question is - Why did it fail ? and What can we do differently the next time?

The knee
jerk response is to order lots of additional tests , and use these to start
offering additional options, such as using donor embryos or surrogacy or donor
eggs, none of which makes any sense to me if the cycle went well. .

If the
cycle was medically perfect, then it's just a question of being patient , and
repeating the cycle until it works .

What about
all the extra expensive tests which doctors doctor after the IVF failure, such
as ERA testing ?

If these
tests were really helpful, then ideally these should have been done before the
cycle wasstarted ! Why wait for the
cycle to fail before running these tests?

Sometimes
patients need to understand that IVF has its own limitations , and we don’t
have all the answers. Doing more tests will just add to the confusion, and not
provide any additional useful actionable information !